The type of blood chambers to which the invention pertains have been widely used to monitor a patient's hematocrit and oxygen saturation levels during conventional hemodialysis treatments. Patients with kidney failure or partial kidney failure typically undergo hemodialysis treatment in order to remove toxins and excess fluids from their blood. To do this, blood is taken from a patient through an intake needle or catheter which draws blood from an artery located in a specifically accepted access location (for example, a shunt surgically placed in an arm, thigh, subclavian, etc.). The needle or catheter is connected to extracorporeal tubing that is fed to a peristaltic pump and then to a dialyzer that cleans the blood and removes excess water. The cleaned blood is then returned to the patient through additional extracorporeal tubing and another needle or catheter. Sometimes, a heparin drip is located in the hemodialysis loop to prevent the blood from coagulating. By way of background, as the drawn blood passes through the dialyzer, it travels in straw-like tubes within the dialyzer which serve as semi-permeable passageways for the unclean blood. Fresh dialysate solution enters the dialyzer at its downstream end. The dialysate surrounds the straw-like tubes and flows through the dialyzer in the opposite direction of the blood flowing through the tubes. Fresh dialysate collects toxins passing through the straw-like tubes by diffusion and excess fluids in the blood by ultra filtration. Dialysate containing the removed toxins and excess fluids is disposed of as waste.
It is known in the art to use an optical blood monitoring system during hemodialysis, such as the CRIT-LINE® monitoring system sold by the assignee of this application. The current CRIT-LINE® blood monitoring system uses optical techniques to non-invasively measure in real-time the hematocrit and the oxygen saturation level of blood flowing through a hemodialysis system or other systems involving extracorporeal blood flow. When the CRIT-LINE® system is used with conventional hemodialysis systems, a sterile, single-use blood chamber is usually attached in-line to the extracorporeal tubing on the arterial side of the dialyzer. The blood chamber provides a viewing point for optical sensors during the hemodialysis procedure. Multiple wavelengths of light are directed through the blood chamber and the patient's blood flowing through the chamber, and a photodetector detects the resulting intensity of each wavelength. The preferred wavelengths to measure hematocrit are about 810 nm (e.g. 829 nm), which is substantially isobestic for red blood cells, and about 1300 nm, which is substantially isobestic for water. A ratiometric technique implemented in the CRIT-LINE® controller, substantially as disclosed in U.S. Pat. No. 5,372,136 entitled “System and Method for Non-Invasive Hematocrit Monitoring”, which issued on Dec. 13, 1999 and assigned to the assignee of the present application, uses this information to calculate the patient's hematocrit value in real-time. The hematocrit value, as is widely used in the art, is the percentage determined by dividing the volume of the red blood cells in a given whole blood sample by the overall volume of the blood sample.
In a clinical setting, the actual percentage change in blood volume occurring during hemodialysis can be determined, in real-time, from the change in the measured hematocrit. Thus, an optical blood monitor, such as the CRIT-LINE® monitor, is able to non-invasively monitor not only the patient's hematocrit level but also the change in the patient's blood volume in real-time during a hemodialysis treatment session. The ability to monitor real-time change in blood volume facilitates safe, effective hemodialysis.
The mathematical ratiometric model for determining the hematocrit (HCT) value can be represented by the following equation:
                    HCT        =                  f          ⁡                      [                                          ln                ⁡                                  (                                                            i                      810                                                              I                                              0                        -                        810                                                                              )                                                            ln                ⁡                                  (                                                            i                      1300                                                              I                                              0                        -                        1300                                                                              )                                                      ]                                              Eq        .                                  ⁢                  (          1          )                    where i810 is the infrared intensity detected by the photoreceiver at 810 nm, i1300 is the infrared intensity detected at 1300 nm and I0-810 and I0-1300 are constants representing the infrared intensity incident on the blood accounting for losses through the blood chamber. The function ƒ[ ] is a mathematical function which has been determined based on experimental data to yield the hematocrit value. Preferably, the function ƒ[ ] in the above Equation (1) is a relatively simply polynomial, e.g. a second order polynomial. The above Equation (1) holds true only if the distance traveled by the infrared radiation from the LED emitter to the photodetectors at both wavelengths is a constant distance.
The mathematical ratiometric model for determining oxygen saturation level (SAT) can be represented by the following equation:
                    SAT        =                  g          ⁡                      [                                          ln                ⁡                                  (                                                            i                      660                                                              I                                              0                        -                        660                                                                              )                                                            ln                ⁡                                  (                                                            i                      810                                                              I                                              0                        -                        810                                                                              )                                                      ]                                              Eq        .                                  ⁢                  (          2          )                    where i660 is the light intensity of the photoreceiver at 660 nm, i810 is the detected intensity at 810 nm and I0660 and I0829 are constants representing the intensity incident on the blood accounting for losses through the blood chamber. The function g[ ] is a mathematical function determined based on experimental data to yield the oxygen saturation level, again preferably a second order polynomial. Also, like Equation (1) for the hematocrit calculation, Equation (2) for the oxygen saturation level calculation holds true only if the distance traveled by the light and infrared radiation from the respective LED emitter to the respective detector at both the 660 nm and 810 nm wavelengths is a constant distance. Similar as in the case with the calculation for hematocrit, errors in the oxygen saturation value can occur if there are errors in the measured intensity at the 660 nm or 810 nm wavelength. And also, while such errors are not common, the most prolific source of such errors is ducting of light through the blood chamber.
As described in more detail below under the heading Detailed Description of the Drawings, the blood chamber used in the current system comprises a molded body made of clear, medical-grade polycarbonate. The chamber body along with the tube set and dialyzer are replaced for each patient and the blood chamber is intended for a single use. The blood chamber provides an internal blood flow cavity, a flat viewing region and two viewing lenses: one being integrally molded with the body of the polycarbonate blood chamber and the other being welded into place. The LED emitters and photodetectors for the optical blood monitor are clipped into place on the blood chamber over the lenses.
The clear polycarbonate blood chamber tends to duct visible light and infra-red light from the LED emitters so that some of the light intensity sensed by the detectors does not pass through the same distance as along the direct path from the LED emitter to the detector through the blood flow in the viewing area. If this stray visible light or stray infra-red light is not attenuated, the system can generate an error that is not easily modeled or extracted during calibration. The prior art blood chamber is molded with a moat around the flat viewing region in the blood flow cavity between the viewing lenses. The moat holds a relatively thick layer of blood, and helps to attenuate ambient light as well as light piping inaccuracies. The blood-filled moat attenuates visible and infrared light that has ducted through the chamber and refracted on a path towards the respective photodetector.
It has been discovered that, even with a moat, errors due to light ducting can occur when making low level oxygen saturation measurements if the patient has a very low hematocrit level (e.g. HCT<about 15).
The full dynamic range for the oxygen saturation signal through blood at the 660 nm wavelength is approximately 500:1. For normal hematocrit levels, the moat in the blood chamber is full of red blood cells and sufficiently isolates the photodetector from ducted light at the 660 nm wavelength so that the measurement of oxygen saturation levels is accurate over the entire dynamic range of expected oxygen saturation levels. However, when the patient's hematocrit drops below about 15 there are fewer red blood cells in the moat and its signal isolation capabilities are compromised. Under these circumstances, light piping can cause inaccuracies in the detection of oxygen saturation levels. As mentioned, the calculation of the oxygen saturation level is based on a ratiometric model of detected intensities at 660 nm (red) and 810 nm (infrared) after the radiation passes through the blood chamber lenses and the blood flowing through the blood chamber. It has been experienced that the expected dynamic range of the signals at 810 nm is about 20:1 whereas the expected dynamic range of the signals at 660 nm is about 500:1. Due in part to the large expected dynamic range of the signals at 660 nm, error introduced by light piping (at low HCT levels) competes with the resolution of the oxygen saturation signal at low levels.
In recent years, the CRIT-LINE® optical blood monitor has been used in more applications where the access point for the extracorporeal blood draw is through a catheter containing the patient's venous blood. Nearly all patients with serious illness or condition have a low hematocrit level. Low hematocrit levels facilitate more errant light piping in the current blood chamber as the red cell content in the moat depletes. The measurement accuracy of oxygen saturation levels is thereby compromised. Such applications where venous measurements are made can include major surgery and in intensive care units, Current studies indicate a strong correlation between venous oxygen saturation level and cardiac output. A typical oxygen saturation level for a healthy individual might be 95% for arterial blood and about 65% for venous blood. A venous oxygen saturation level of 50% or below would raise reason for concern for the patient's condition. The need to accurately measure low oxygen saturation levels in venous blood in particular is becoming more prevalent in these types of applications in addition to the conventional hemodialysis applications. Other applications in which low oxygen saturation levels are somewhat more likely are also becoming more prevalent.